摘要
目的探讨急性前循环大面积脑梗死血管内治疗的安全性及有效性,明确影响其预后的相关因素。方法回顾性分析河南省人民医院脑血管二病区自2018年2月至2019年12月收治的34例行血管内治疗的大面积急性前循环脑梗死患者临床资料,记录患者围手术期出血率和死亡率;以改良Rankin量表(mRS)评分作为标准评价患者90 d随访时预后情况,并对影响大面积脑梗死患者预后的相关因素进行分析。结果30例患者(88.2%)成功开通,手术时间为(97.41±54.58)min,取栓次数为(1.91±0.75)次。4例患者(11.8%)发生远端栓塞;非症状性出血3例(8.8%)、症状性出血3例(8.8%);7例(20.6%)发生脑疝;死亡5例(14.4%)。90 d随访期内13例(38.2%)预后良好,21例(61.8%)预后不良,2组患者的入院时美国国立卫生研究院卒中量表(NIHSS)评分、血栓负荷量评分、DWI梗死位置、DSA闭塞部位、术前静脉溶栓、脑疝等因素差异有统计学意义(P<0.05),其中入院时NIHSS评分(OR=0.817,95%CI:0.682~0.980,P=0.029)、血栓负荷量评分(OR=5.981,95%CI:1.827~19.575,P=0.003)、DSA闭塞部位(OR=0.031,95%CI:0.003~0.311,P=0.003)、术前静脉溶栓(OR=0.092,95%CI:0.01~0.838,P=0.034)是影响急诊血管内治疗预后的独立因素。结论前循环大面积脑梗死患者血管内开通治疗后预后较好。低NIHSS评分患者、高血栓负荷量评分患者、大脑中动脉闭塞患者及直接行血管内治疗患者预后相对更好。
Objective To investigate the safety and efficacy of endovascular treatment in acute anterior circulation massive cerebral infarction and its prognostic factors.Methods A retrospective analysis was performed on clinical data of 34 patients with acute anterior circulatory massive cerebral infarction who received intravascular treatment in our hospital from February 2018 to December 2019.The perioperative hemorrhage rate and mortality rate were analyzed in these patients.Modified Rankin scale(mRS)scores were taken as the evaluation standard in the prognoses of these patients during the 90 d of follow up,and the influencing factors afifecting the prognoses of patients with massive cerebral infarction were analyzed.Results The operation was successful in 30 patients(88.2%);the operation time was(97.41±54.58)min,and the number of thrombolysis was(1.91±0.75)times.Distal embolization occurred in 4 patients(11.8%);there were 3 patients with non-symptomatic hemorrhage(8.8%)and 3 patients with symptomatic hemorrhage(8.8%).Cerebral hernia occurred in 7 patients(20.6%);there were 5 deaths(14.4%).During the 90 d of follow up,13 patients(38.2%)had good prognosis,and 21(61.8%)had poor prognosis;there were statistically significant differences in NIHSS scores at admission,infarction locations in diffusion weighted imaging,vascular occlusion locations in DSA,pecentages of patients accepted preoperative intravenous thrombolysis and patients with cerebral hernia between the two groups(P<0.05).NIHSS scores at admission(OR=0.817,95%CI:0.682-0.980,P=0.029),thrombus load scale scores(OR=5.981,95%CI:1.827-19.575,P=0.003),vascular occlusion locations in DSA(OR=0.031,95%CI:0.003-0.311,P=0.003)and pecentage of patients accepted preoperative intravenous thrombolysis(OR=0.092,95%CI:0.010-0.838,P=0.034)were independent factors influencing the prognoses of emergency intravascular treatment.Conclusions Endovascular recanalization can achieve a relatively good prognosis in patients with massive cerebral infarction.Patients with low NIHSS scores
作者
李强
周腾飞
贺迎坤
管民
李钊硕
吴立恒
冯光
王子亮
朱良付
李天晓
Li Qiang;Zhou Tengfei;He Yingkun;Guan Min;Li Zhaoshuo;Wu Liheng;Feng Guang;Wang Ziliang;Zhu Liangfu;Li Tianxiao(Unite Two,Department of Cerebrovascular Diseases,People's Hospital,Zhengzhou University(Henan Provincial People's Hospital),Zhengzhou 450002,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2020年第7期671-676,共6页
Chinese Journal of Neuromedicine
基金
国家脑卒中高危人群干预适宜技术研究及推广项目(GN-2016R0006、GN-2018R0007)
河南省科技攻关项目(202102310037)
河南大学一流学科培育项目(2019YLZDJL11)。
关键词
血管内治疗
大面积脑梗死
前循环
Intravascular treatment
Massive cerebral infarction
Anterior circulatory
